Abstract
BackgroundThe Alternative DSM-5 Model for Personality Disorders as well as the upcoming IDC-11 have established a new focus on diagnosing personality disorders (PD): personality functioning. An impairment of self and interpersonal functioning in these models represents a general diagnostic criterion for a personality disorder. Little is known so far about the impairment of personality functioning in patients with other mental disorders than PD. This study aims to assess personality functioning in patients with anxiety disorders.MethodsNinety-seven patients with the diagnosis of generalized anxiety disorder, panic disorder, or phobia, and 16 healthy control persons were diagnosed using the Structured Clinical Interview for DSM-IV (SCID-I and -II) and were assessed by means of the Structured Interview for Personality Organization (STIPO) to determine the level of personality functioning.ResultsWhile all three patient groups showed significant impairment in personality functioning compared to the control group, no significant differences were observed between the different patient groups. In all three groups of anxiety disorders patients with comorbid PD showed significantly worse personality functioning than patients without. Patients without comorbid PD also yielded a significant impairment in their personality functioning when compared to the control group.ConclusionsAnxiety disorders are associated with a significant impairment in personality functioning, which is significantly increased by comorbid PD. There are no differences in terms of personality functioning between patients with different anxiety disorders.
Highlights
The Alternative DSM-5 Model for Personality Disorders as well as the upcoming IDC-11 have established a new focus on diagnosing personality disorders (PD): personality functioning
Patients and control subjects were diagnosed according to DSM-IV [18] by means of SCIDI and -II [19, 20] and underwent the Structured Interview for Personality Organization (STIPO) [10]
Our data demonstrate that anxiety disorders are associated with an impaired personality functioning, which is moderate when no comorbid personality disorder is present and more severe in case of comorbid PD
Summary
The Alternative DSM-5 Model for Personality Disorders as well as the upcoming IDC-11 have established a new focus on diagnosing personality disorders (PD): personality functioning. Hartmann emphasized the relevance of ego functions for psychosocial adaptation as opposed to neurotic conflicts in the aetiology of mental disorders [6] In his conceptual work Kernberg [7, 8] elaborated the impact of early experiences in relationships on the maturation of psychic structure or – in his words – personality organization. Patients with impaired personality function (Kernberg coined the term “borderline personality organization” for this group) suffer from identity diffusion, i.e., their internal images of the self and significant others are contradictory, superficial, and not integrated They are not able to maintain stable interpersonal relationships, are vulnerable to stress (employ primitive defence mechanisms), suffer from impaired impulse control, especially in terms of self-directed and otherdirected aggression, and tend to have less stable moral values and behaviour. In addition to an even worse personality functioning in all of the described domains they suffer from an impaired reality testing
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